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Author: Suzanne Leclerc-Madlala
Title: Masculinity and AIDS in Kwazulu-Natal: A Treatise
Publication info: Ann Arbor, Michigan: MPublishing, University of Michigan Library
June 2005

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Source: Masculinity and AIDS in Kwazulu-Natal: A Treatise

no. ns 2, June 2005


Suzanne Leclerc-Madlala

School of Anthropology, Gender and Historical Studies, University of KwaZulu-Natal

Over time it has become increasingly clear that poverty conditions provide much of the lethal context in which HIV/AIDS flourishes. Having burrowed its way into the world's poorest communities, the AIDS pandemic is now viewed primarily as a phenomenon of the developing world. Interwoven in the fabric of many impoverished environments is a life course typified by predictably structured social relations whereby, in an effort to survive, people are prone to an array of behaviors that make them vulnerable to HIV/AIDS. In KwaZulu-Natal where I have been conducting research on HIV/AIDS for over a decade, growing economic disparities have resulted in a stark contrast between rich and poor who often live side-by-side. Here people, especially young people, are eager to be counted amongst the 'haves' as opposed to the 'have-nots'. Strategies to survive in the midst of this modern poverty are not all aimed at simply putting enough food on the table. Whatever it takes to own a pair of fashion-label denims, a top-of-the-range cellular phone, or to partake in the wining and dining of the nouveau riche, young people are often quite prepared to take risks to escape the grip and personae of being poor. Whether spawned out of a basic need or a desire to acquire commodities or have fun, young people here, as everywhere in the world, are apt to live for the moment and take chances. The problem arises when the environment is marked by high rates of HIV, as is the case in KwaZulu-Natal province. Then, the chances and risks being taken by young people are nothing less than gambles with one's own life and the lives of others.

The rapid heterosexual spread of HIV/AIDS across sub-Saharan Africa has brought not only poverty but also gender inequities firmly under the spotlight of researchers, policy makers and health planners. In South Africa the acknowledgement of a link between poverty, gender inequality and vulnerability to AIDS led to the 1990s being characterized as the decade of 'Women and AIDS' discourse and AIDS interventions aimed at women. Government health departments, non-government organizations, school and church groups took up the prevention challenge as a challenge to 'empower' women to defend themselves against HIV infection. The then-current belief was that if women could become sufficiently skilled at negotiating safer sex, become more active in decision making around sex, more confident in expressing their views, feelings and desires, and more able to have their opinions heard and respected by their partners, then the rapid spread of the HI virus would be halted in its pace, if not altogether stopped. Sadly, in retrospect, it seems we were wrong.

With the turn of the century we have come to realize that there was another variable that had not been, what is referred to in epidemiological parlance, 'controlled for'. That was men. Through our experiences (and failures) in trying to prevent the spread of HIV/AIDS, it has become abundantly clear that unequal power balances in gender relations that favor men translate into unequal power balances in heterosexual interactions that disfavor women. Throughout the world dynamics between men and women are structured in highly predictable ways. The mating and dating game, although changing constantly in form and substance, is not so dissimilar across cultures. Details of body language may differ, ideas about what constitutes attractiveness, appropriate dress, language and communication styles, or attitudinal and behavioral norms may vary between groups, but similar gender expectations exist in most all societies. The idea that it is up to men to 'make the first move' when initiating a relationship, or that women should play the time honored game of 'hard to get' by demonstrating at least some degree of coyness, are expectations that resonate around the world. As a species we may be heir to a wealth of cultural creativity, but at a very basic level our mating rituals are almost as predicable and patterned as those of any peacock or bonobo [Pan paniscus, or the pygmy chimpanzee] community.

Numerous studies on AIDS and gender in Africa have revealed many similar patterns that serve to curtail women's sexual autonomy and expand men's sexual freedom. These patterns, supported by pervasive patriarchal orientations to life, have the effect of increasing women's and men's risk and vulnerability to HIV. What we in South Africa have come to realize (perhaps better late than never), is that the empowerment of women is a useless exercise if the other half of the equation, men, continue to disempower them. In the time of AIDS, it is increasingly and painfully clear that gendered relations of power have alarming implications for our ability to halt the sexual transmission of HIV. The light that this new knowledge has shed on our local understanding of the social and cultural dimensions of HIV/AIDS has had the effect of bringing the role of men and hegemonic notions of masculinity into sharp research and intervention focus.

When it comes to sex it obviously takes two to tango. Yet when we look at how men are socialized, with Zulu men in KwaZulu-Natal being our particular case example, we are left with little doubt about men's complicity in the growth of this sexually transmitted pandemic. Likewise, we are left with little doubt about the enormity of a task that essentially constitutes a socio-cultural offensive against certain notions and norms of masculinity that need to be challenged if further growth of this disease is to be slowed. In general, Zulu men are raised to be self-reliant, not to show emotions, and not to seek assistance in times of need or stress. This expectation of invulnerability runs counter to the expectations that men should protect themselves from potential infection and encourages denial of risk. It also prevents men from seeking voluntary counseling and testing to establish their HIV status in the first place, and militates against disclosing their HIV status to others, including their sexual partners. Conceptions of maleness amongst the Zulu share near-universal ideals of masculinity which emphasize the qualities of strength and daring, of having the guts to take risks. To prove themselves as men, men are to a large extent socially propelled towards risky behavior for fear of being called an isishimane, a word that means 'sissy' or 'less than a man'.

The traditional ideal of being an amasoka, a man who is popular with women, encourages men to prove their manhood through liaisons with women. A man with a reputation of having many previous and current girlfriends wears this reputation as a badge of esteemed Zulu manhood. For men, multiple sexual partnerships are commonly viewed as natural and in many ways as essential to men's nature as men. This model of male sexuality seriously challenges the effectiveness of prevention messages that call for abstinence before marriage, a reduction in the number of sexual partners, or faithfulness and greater trust and mutuality between partners. This macho ideal also contributes to homophobia and the stigmatization of men who have sex with other men. Social stigma forces men who do have sex with other men to hide their sexual activity and deny their sexual risks, thus increasing their own risk as well as their partners, male and female.

In traditionally patrilineal societies such as the Zulu where high brideweath payments were (or still are) made to secure wives through the payment of ilobola, sexual domination goes hand in hand with notions of male control over women. A man demonstrates his manliness by demonstrating how well he can assert control over 'his' women be they wives, girlfriends or daughters. This deeply embedded notion even extends into the workplace and school environment, with men displaying their manhood in ways that result in the sexual harassment of female colleagues or the sexual abuse of schoolgirls by teachers. Recent research is elucidating links between a woman's experiences with sexual coercion and violence, and later risky behavior such as having multiple sexual partners, trading sex for money or drugs, and a high likelihood of engaging in unprotected sex. No doubt these entrenched ideas contribute to the acceptance of violence against women, including sexual violence, a crime that has reached epidemic proportions in KwaZulu-Natal and throughout South Africa. This situation directly adds to a woman's early vulnerability to HIV and her continued vulnerability to HIV throughout her life. Today rape and AIDS in South Africa are co-epidemics that are closely intertwined. While it might seem startling, we must be prepared to accept the idea that the very same attitudes and behaviors that we now know have facilitated the rapid spread of HIV/AIDS in KwaZulu-Natal are nothing more sinister than men simply living up to what is expected of them.

Calle Almedal, a senior official with the joint United Nations AIDS program stated at the close of the last century that men in fact drove the AIDS epidemic. He suggested that only prevention programs that directly address men's sexual behavior could significantly reduce the rate at which the global HIV/AIDS epidemic spreads. Closer to home, an African male speaker at the close of the First Durban AIDS Conference in 2003 stated that in the case of other diseases knowing the main vector of infection would normally result in a big effort to destroy that vector. However, he noted, in the case of AIDS, even when we know the main vector is men, we do nothing. The audience roared with laughter.

Nonetheless the start of the new century brought with it the realization that we have to work more closely with men if we hope to curtail our ever-growing AIDS epidemic. HIV prevention in South Africa today is about taking better cognizance of how society constructs its messages on what it means to be a man or a woman, and how the male dominated environment shapes the way sex is negotiated, when, why, how and by whom. With the focus of HIV prevention having largely shifted from women to men, some local HIV/AIDS program planners now start from the premise that less-than-responsible sexual behavior on the part of a large number of men has enabled the epidemic to grow into the enormous problem that it is today. But recognition of the need to work with men is much easier said than done. Men, whether they are Zulu men, Hmong men, Arapesh men or Canadian men, occupy the most dominant positions in societies everywhere. Unlike the more subordinate and socially oppressed members of society, they are often difficult to reach and work with. In South Africa several organizations with names such as Men As Partners, Soshaloza Football Club, The Fatherhood Project and The Men's Forum have been established in recent years to specifically work with men and develop models on how best to engage with them. Rather than seeing the unequal heterosexual equation as a problem whereby women require 'empowerment' and the natural consequence for men would be then be 'disempowerment' of some kind, the aim of these new programs is to create a context for greater mutuality between men and women. But we are still unsure about how to do that. In addition we have no idea about the social consequences of challenging hegemonic masculinities and promoting more gender sensitive, less aggressive 'new man' types of masculinities. We all assume that 'society' will somehow be made better. But better in what sense? Better in whose eyes? And better for what end? We still have a long way to go with any gender and AIDS project that includes the nurturing of 'new men' for a new South Africa.

And therein lies the challenge. How do we effectively address the lethal context in which poverty, cultural expectation, gender and HIV/AIDS intersect and interact to produce and promote such a vicious epidemic? At the very least interventions must not reinforce what are ultimately damaging and dangerous gender stereotypes. Approaches are needed at various levels to transform gender norms and expectations and create more gender-equitable relationships. Ways need to be found that 'empower' men to resist and challenge dominant social expectations of masculinity while at the same time affirming their manhood. Ultimately interventions that free both women and men from destructive gender and sexual norms require supportive policy and legislative contexts, if not the wholehearted commitment of government leaders.

The gender work that is required to strike a real blow at AIDS is nothing less than profound. It means deconstructing old habits of thought and behavior that have developed over centuries, and replacing them with new thoughts that often run directly counter to most everything held sacred and dear in the name of culture or tradition. Yet we South Africans cannot afford to shrink in the face of this transformation challenge. The cost of maintaining sociocultural norms and expectations that give men a false sense of power and oppress women are literally killing us. High-risk notions of masculinity that propel the growth of HIV/AIDS must be put firmly on the social change agenda. Poverty alleviation alone will not be enough. If we are serious about preventing the future growth of the AIDS epidemic, we have little choice but to try to change the way we have historically conceived, constructed and expressed our gendered selves. Perhaps the first question that we should be asking ourselves is whether or not we are at all serious about dealing decisively with this epidemic.

Suzanne Leclerc-Madlala, B.A. (Univ. of Rhode Island), M.A. (George Washington University), Ph.D. (Natal Univ.), is an Associate Professor and currently Head of the Anthropology Program at the Durban campus of the University of KwaZulu-Natal. She has previously lectured at the George Washington University, the Universities of Transkei and Durban-Westville, and the State Lyceum at Koula-Moutou in Gabon. A medical anthropologist by training, her interests are in the diverse fields of human evolution, gender and sexuality, psychological anthropology, reproductive rights and sociocultural constructions of disease. Having conducted research on indigenous therapeutics in Gabon at the Dr. Albert Schweitzer Hospital, her studies of the past decade has focused on HIV/AIDS in KwaZulu-Natal, where she is active in the training and evaluation of AIDS interventions with youth, virginity testers and traditional healers. Prof. Leclerc-Madlala is widely published and internationally recognized as an authority on social and cultural aspects of the AIDS pandemic in Africa.

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